Caught between Floating and Drowning, a reflection about poetry, memory and adapting to chaos by Mikayla Brockmeyer

A state of flux. The COVID-19 pandemic has induced a state of “How will I react to _____?” Listlessness and emotional exhaustion bring about feelings of isolation and longing to be somewhere we are not. Yet, in learning to modify behaviors, collaborations have emerged.

In the opening couplet to Sheila Kelly’s poem entitled “Breathe” (Fall 2017 Intima). she sets the stage and introduces a poignant metaphor, depicting calmness, yet incertitude.

You are floating in the swimming pool again.
Your childhood best friend rises like prayer.

“Breathe” was penned well before the current pandemic, yet the feelings of serenity and safety one day, and panic the next, expressed are relevant today. Using a second-person narrative, she paints a vivid picture of a disjointed home life, sifting through old, painful memories. In the poem, the main character is catapulting between chaos and “floating in the swimming pool.” At the end, I interpret a sense of adaptation from the character that leaves a residue of hope.

In my essay “Turbulent Undertow” (Fall 2020 Intima), parallel feelings are grappled with, as I describe a surfing attempt, and later, my experience as a hospitalist scribe. Woven together, I write about two near-drowning experiences: on surfing and on caring for patients with COVID-19. The best friend in Sheila Kelly’s poem encourages the main character to put on her old swimsuit when distressed. After a long series of days working with the hospitalist, I, too, wanted to offer solace. But instead, all I could offer was “Glad you’re okay,” a phrase that has reverberated through my brain ever since I first heard it myself.

Riding metaphorical surfboards together and finding ways to float in metaphorical swimming pools may not be the best solution to curb the emotional toll of the pandemic. However, validation and shared human connection serve as two ways to avoid possible drowning amidst the pandemic waves.

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Mikayla Brockmeyer

Mikayla Brockmeyer is a first year osteopathic medical student at Des Moines University in Des Moines, Iowa. She began working as a hospitalist scribe in 2018, while she was enrolled in the Master of Science in Biomedical Sciences program at Des Moines University. She successfully defended her thesis in 2019 and spent her gap year scribing full time. This is her first time showcasing her storytelling abilities in a public arena. Her non-fiction essay “Turbulent Undertow” appears in the Fall 2020 Intima.

‘New Normal. Precious Normal.’ A Reflection about Loss and Love in the Wake of COVID-19 by poet Sophia Wilson

In her poem “Oxygen” (Fall 2018 Intima), Hollis Kurman captures how poignantly the proximity of illness or death can alter the way we view others and the world:

‘…he lies
wordless, feet stilled and arms bound.
His glasses have been removed,
His pockets emptied. A life fills

those pockets, the tokens and coins,
Addresses and appointments. Cash, still.
Hints of barter expired.’

Currently, here in New Zealand, the combination of a small population (total five million), and nationwide lockdown has flattened the initial COVID-19 curve. There have been no new cases for most days over the past two weeks. The country has re-opened schools and businesses. Domestic tourism is being aggressively encouraged. There’s been a rush on fast food. Traffic is back on the roads in force.

Simultaneously, there is a risk of complacency and resurgence of infection.

It’s almost hard to recall, how we felt at the beginning of lockdown. As circumstances brought about by the pandemic change rapidly, so too, do our emotions and responses.

While the focus in New Zealand is on a return to ‘normal,’ there is also a sense of the importance of moving forward differently, in particularly with regards to the environment and each another. Today, as it happens, is not only the release date of the Spring 2020 Intima, in which my poem “Don’t Leave” appears, but the day my husband (an essential worker and subject of the poem), moves back into our home—a cause for celebration. It’s also the day I receive news that a close relative is intubated in intensive care in a Sydney hospital, with suspected COVID-19 infection. He’s forty-five years old with no comorbidity. Our loved one was well when we spoke to him last week. It’s an acute reminder the nightmare is not over.

What wouldn’t we do to keep those we love safe and close? As Hollis Kurman so movingly writes:

‘Wait, we’ve not yet

spoken today; wait, take my oxygen;
wait, the policeman called you “sir” in the
middle of the night, carrying you back to bed.
Wait.’

Both our poems express an acute appreciation for the preciousness of other people, those so familiar to us we have come to take them for granted. In my case, as for so many of us right now,  this heightened appreciation has been catalysed forcefully by COVID-19.  I hope that, like the quiet, paused moments of lockdown, it does not slip away amid the hustle and bustle of a return to ‘normality.’

Thank you, Hollis. Your poem will stay with me. And thank you, Intima, for all the brave and inspiring work you support and share.

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Sophia Wilson is a New Zealand-based writer and mother of three with a background in arts, medicine and psychiatry. Her work has appeared in StylusLit, Not Very Quiet, Ars Medica, Hektoen International, Intima, Distāntia off topic poetics, NZ Poetry Shelf, Poems in the Waiting Room, Corpus, The Otago Daily Times and elsewhere. In 2019 the manuscript for her first children’s novel, “The Guardian of Whale Mountain” was selected in the top ten for the Green Stories Competition (UK). She was shortlisted for the Takahē Monica Taylor Prize and a finalist in the Robert Burns Poetry Competition. She was winner of the 2020 International Writers Workshop Flash Fiction Competition and is the recipient of a 2020 Creative New Zealand grant.

Swimming Alone: Thoughts on What It’s Like Being a Medical Student Thrown Into the Proverbial Deep End of the Hospital Wards by Thomas J. Doyle, MD

Thomas J. Doyle MD is an internist who lives in Providence, Rhode Island. His Field Notes essay "To Pronounce" appeared in the Spring 2018 Intima: A Journal of Narrative Medicine.

I can’t recall the first time I performed a death pronouncement. I’m sure I was taught how to diagnose death, but I can’t summon to mind much in the way of specifics. My recollections are vague, often from nights on call as a student or intern tagging along with senior residents as they performed death pronouncements on the wards.

On the other hand I can immediately summon to mind many other experiences from the pressure cooker of medical training. I can visualize the frothy trachea of an enormous man in respiratory failure whom I successfully intubated during a rotation in the ICU. I still cringe recalling ribs cracking under my palms as I performed CPR on a frail elderly man. I pushed rapidly on his sternum and recoiled internally even as I knew my technique was correct, recalling an attending’s advice that “sometimes you need to break some ribs for a good cardiopulmonary massage.”

I feel a personal sense of loss that I didn’t write down the emotional impact of my early experiences in learning to diagnose death. My essay “To Pronounce” is an attempt to make up for that loss.

And it is with that sense of loss in mind that I applaud William Fyfe for his essay “No Time For Tears Today,” published in the Fall 2017 Intima: A Journal of Narrative Medicine under ‘Field Notes.’ In concise, immediate, elegant prose, he captures the essence of what it’s like to be a medical student thrown into the proverbial deep end of the hospital wards. Many of Fyfe’s words resonate with my memories of training: “chaos,” “imposter,” “sheepish,” “drained,” “ashamed,” “unexpected.”

In particular, his essay captures an unspoken lesson students are expected to absorb while keeping their heads above water – that in medicine we are expected to swim because – well, because that’s just what we have to do.

Fyfe’s prose, however, hints at the emotional isolation that can creep into our lives in medicine very early on, and locates the reader squarely in the proverbial moment when we may momentarily “get it together” to confidently function with humanity.

I like to think that Fyfe’s title is intended to convey a touch of irony because, after all, a decent amount of the reason there are so many among us who become numb or burned out is because we can’t, or don’t, let ourselves have time for tears at least once in a while.

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Thomas J. Doyle MD is an internist who lives in Providence, Rhode Island. He graduated from The Warren Alpert School of Medicine at Brown University in 2003 and completed training in internal medicine at Rhode Island Hospital. He practices inpatient hospital medicine at Charlton Memorial Hospital in Fall River, MA. His Field Notes essay "To Pronounce" appeared in the Spring 2018 Intima: A Journal of Narrative Medicine

We Need More Stories From Young Patients by Kelley Yuan

Kelley Yuan will begin her studies at Sidney Kimmel Medical College in 2018 as part of the Penn State/SKMC combined BS/MD program. Her paper entitled "Stories from Kids: The Unheard Voices of Pediatric Patients" appears in the Spring 2018 Intima: A Journal of Narrative Medicine.

Thousands upon thousands of patient narratives. Remember the one from the eleven year old? Me neither.

We need more stories from young patients. They experience illness and emotions just as exquisitely as adults, if not more so. From their accounts we stand to learn a great deal about pain, hope and resilience. My piece, Stories from Kids: The Unheard Voices of Pediatric Patients, represents a small fraction of the many younger voices that narrative medicine has overlooked.

A great example of seeking youth voices is Ali Grzywna’s work, Anorexia Narratives: Stories of Illness & Healing. The accounts she gathered from anorexic teens and adults reveal how anorexia gave them a sense of control, a coping mechanism for other stressors, or a form of identity. Notably, she featured teen voices and the teen experience.

Based on this understanding of the underlying thought processes, therapy has evolved to treat anorexia. Instead of casting off the anorexic identity, patients learn to reshape the narrative to change their behavior—learning to select the healthy voice over the anorexic voice, instead of muting the anorexic voice altogether. Teen stories spurred progress.

Our current understanding of how children and adolescents interpret illness is dreadfully narrow, especially given the recent rise in juvenile autoimmune diseases and adolescent mental health issues. Without the youth perspective, our search for better treatments remains incomplete. The more we seek their stories, the more we can uncover to help these young minds and bodies heal.

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Kelley Yuan will begin her studies at Sidney Kimmel Medical College in 2018 as part of the Penn State/SKMC combined BS/MD program. She studies illustration and fences épée when she should be revising for exams. Her work seeks to capture the rare, light-hearted moments in a field filled with pain, fear, and tough decisions. Her paper entitled "Stories from Kids: The Unheard Voices of Pediatric Patients" appears in the Spring 2018 Intima: A Journal of Narrative Medicine.

Life and Death in the ER: What's Real, What's Fiction? by Carol Scott Connor

Carol Scott-Conner is Professor Emeritus of Surgery at the University of Iowa Carver College of Medicine. Her story "After Midnight" is homage to the night shift, when everything extraneous seems to fade away and only life and death remain.

Readers of my piece "After Midnight" often ask me, “What happened to the cop?”

I answer, “It’s fiction. There never was any cop.” But the truth is more complex than that.

There were patients very similar to this during my medical school and residency years. From those memories I can say with confidence that although the piece ends with the cop about to arrive, alive, in the Recovery room, he almost certainly would not have survived to leave the hospital. As subsequent decades passed, we became more facile in resuscitation, better attuned to the factors that predict a successful outcome. In that time, at that place, we simply did everything we could to fight for life.

As you may have guessed, the piece is firmly rooted in my own experience as a wide-eyed medical student. Originally destined for a career in the cerebral specialty of cardiology, I became a convert to surgery after a night when the team (at least temporarily) cheated death and everything seemed possible. When the swoosh of the dark wings of death could be heard, and we seemed to be able to beat that old carrion-bird back into the darkness. And the night ended with a trip across the roof to start rounds.

A far more realistic and nuanced view is presented by Anna Belc in “Getting to Know Dying.” She writes of the early recognition of imminent death in those who are in the zone of criticality. She speaks of anticipating death so as to better be able to prevent it – for example, for a patient at risk of bleeding out, start two large-bore IV’s.

She also speaks of the difficulty preparing the survivors, the family. And, implicit in all of this, is the personal toll on the healthcare team. Those who deliberately choose to work in the zone where life and death intersect are, indeed, very special people.

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Carol Scott-Conner is Professor Emeritus of Surgery at the University of Iowa Carver College of Medicine. She writes memoir in the form of fiction, exploring the world of women in surgery. Her stories have been published in multiple literary journals ranging from “The Healing Muse” through “North Dakota Quarterly,” and nominated for a Pushcart Prize. A collection of her short stories was published as “A Few Small Moments.” She is past editor-in-chief of “The Examined Life Journal: A Literary Journal of the Carver College of Medicine” and currently serves as its fiction editor. "After Midnight" is homage to the night shift, when everything extraneous seems to fade away and only life and death remain.

Life and Death in the ER: What's Real and What's Fiction? by Carol EH Scott-Conner MD PhD

Carol Scott-Conner is Professor Emeritus of Surgery at the University of Iowa Carver College of Medicine. Her story "After Midnight" pays homage to the night shift, when everything extraneous seems to fade away and only life and death remain.

Readers of my piece "After Midnight" often ask me, “What happened to the cop?”

I answer, “It’s fiction. There never was any cop.” But the truth is more complex than that.

There were patients very similar to this during my medical school and residency years. From those memories I can say with confidence that although the piece ends with the cop about to arrive, alive, in the Recovery room, he almost certainly would not have survived to leave the hospital. As subsequent decades passed, we became more facile in resuscitation, better attuned to the factors that predict a successful outcome. In that time, at that place, we simply did everything we could to fight for life.

As you may have guessed, the piece is firmly rooted in my own experience as a wide-eyed medical student. Originally destined for a career in the cerebral specialty of cardiology, I became a convert to surgery after a night when the team (at least temporarily) cheated death and everything seemed possible. When the swoosh of the dark wings of death could be heard, and we seemed to be able to beat that old carrion-bird back into the darkness. And the night ended with a trip across the roof to start rounds.

A far more realistic and nuanced view is presented by Anna Belc in “Getting to Know Dying.” She writes of the early recognition of imminent death in those who are in the zone of criticality. She speaks of anticipating death so as to better be able to prevent it – for example, for a patient at risk of bleeding out, start two large-bore IV’s.

She also speaks of the difficulty preparing the survivors, the family. And, implicit in all of this, is the personal toll on the healthcare team. Those who deliberately choose to work in the zone where life and death intersect are, indeed, very special people.

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Carol Scott-Conner is Professor Emeritus of Surgery at the University of Iowa Carver College of Medicine. She writes memoir in the form of fiction, exploring the world of women in surgery. Her stories have been published in multiple literary journals ranging from “The Healing Muse” through “North Dakota Quarterly,” and nominated for a Pushcart Prize. A collection of her short stories was published as “A Few Small Moments.” She is past editor-in-chief of “The Examined Life Journal: A Literary Journal of the Carver College of Medicine” and currently serves as its fiction editor. "After Midnight" is homage to the night shift, when everything extraneous seems to fade away and only life and death remain.